Western Illinois University
Name: Financial Aid Office
Sherman Hall 127
1 University Circle
Macomb, IL 61455-1390
Phone: 309/298-2446
FAX: 309/298-2353
ID: 2015-16 Parent Income Appeal.online (711)
This form will not be processed if the required documentation listed below is not included. See page 2 for additional instructions and details. SECTION 1: PARENT QUALIFICATIONS
Check one:
Parent 1 __ Parent 2 __ worked in 2014 and is now unemployed in 2015.
Parent 1 __ Parent 2 __ worked full-time in 2014 and is working part-time in 2015.
Other, please explain: _______________________________________________________________________
SECTION 2: DOCUMENTATION
Submit with this form:
1. Copies of both parents’ last pay stub from all jobs worked in 2015, AND
2. Documentation of change in employment (submit all that apply):

UI Wage Claimant Form and most recent pay statement from unemployment office

If not receiving unemployment, employer statement clearly stating date of employment change

If loss of employment is due to disability, physicians statement clearly stating dates of disability

Copy of the DD214 for military discharge in 2014 or 2015 and a copy of most recent LES.
SECTION 3: ESTIMATED 2015 PARENT INCOME
DO NOT LEAVE ITEMS BLANK; enter 0. If items are left blank, form will not be processed.
Total
Estimated
Gross
Estimated
2015 TAXED INCOME - List income that is
Income
Income
reported on a federal tax return:
+ Today thru
= Income for
Since 1/1/15
2015
12/31/15
Parent 1 (Name: _________________________)
Wages, farm/business income
$
+
$
=
$
Parent 2 (Name: _________________________)
Wages, farm/business income
$
+
$
=
$
Unemployment
$
+
$
=
$
All other parents’ taxable income (includes capital
gains, interest/dividends, rental/real estate/
partnership/S-corporations income, alimony, Social
Security income and severance pay)
$
+
$
=
$
2015 UNTAXED INCOME - List income/benefits that are not reported on a federal tax return:
Child support received for all family members
$
IRA, pension distributions, or non-taxable interest income (exclude rollovers)
$
Payments to a tax-deferred pension, IRA, KEOGH/SEP or savings plan
$
Veteran’s non-educational benefits
$
Housing, food, and other living allowances paid to member of the military, clergy & others
Other income not reported on the tax return
$
$
Student’s signature __________________________________________________ Date____________________
Parent’s signature __________________________________________________ Date____________________
Parent’s Phone #
___________________________ Parent’s Email _________________________________
2015-16 PARENT INCOME APPEAL - ADDITIONAL INSTRUCTIONS
SECTION 1: PARENT QUALIFICATIONS



Estimated 2015 income must be significantly less than 2014 income.
Income includes earnings from work, retirement pay, severance pay, lump sum payments, etc.
Loss of overtime cannot be considered until the 2015 tax return is filed.
SECTION 2: DOCUMENTATION
 Parent(s) must submit most recent 2015 paystub(s) available for any job worked.
 Parent(s) must submit documentation confirming their change in employment (see page 1 for examples).
 Parent(s) are encouraged to submit a signed statement explaining their circumstances and summarizing the
calculations used to determine 2015 Total Estimated Income.
SECTION 3: ESTIMATED 2015 PARENT INCOME

GENERAL DEFINITIONS
o Gross Income – income earned during 2015, before taxes.
o Estimated Income – anticipated income to be earned during 2015, calculated using current employment
information.
o Total Estimated Income – add together Gross Income and Estimated Income to provide a total.
 2015 TAXED INCOME
o Parent 1 (father/mother/stepparent) wages, farm/business income – provide gross income Parent 1 has
earned or will earn from working or from self-employment, including farm or other business income. Submit
most recent W-2 or 1099 forms.
o Parent 2 (father/mother/stepparent) wages, farm/business income – provide gross income Parent 2 has
earned or will earn from working or from self-employment, including farm or other business income. Submit
most recent W-2 or 1099 forms.
o Unemployment – provide gross income received from unemployment benefits. Submit UI Wage Claimant
Form and most recent pay statement.
o All other parents’ taxable income – provide any other gross income that would be reported on a tax return
(see page 1 for examples).
 2015 UNTAXED INCOME
o Child support received for all family members – Don’t include foster care or adoption payments.
o IRA, pension distributions, or non-taxable interest income (exclude rollovers) – Payments to tax-
o
o
o
o
deferred pension and retirement savings plans (paid directly or withheld from earnings), including, but not
limited to, amounts reported on the W-2 forms in Boxes 12a through 12d, codes D, E, F, G, H and S. Don’t
include amounts reported in code DD (employer contributions toward employee health benefits).
Payments to a tax-deferred pension, IRA, KEOGH/SEP or savings plan – IRA deductions and payments
to self-employed SEP, SIMPLE, Keogh and other qualified plans from IRS Form 1040—line 28 + line 32 or
1040A—line 17.
Veteran’s non-educational benefits – Includes Disability, Death Pension, or Dependency & Indemnity
Compensation (DIC) and/or VA Educational Work-Study allowances.
Housing, food, and other living allowances paid to member of the military, clergy & others – Include
cash payments and cash value of benefits. Don’t include the value of on-base military housing or the value of
a basic military allowance for housing.
Other income not reported on the tax return – Include the cash value of workers’ compensation, disability,
etc. Also include the untaxed portions of health savings accounts from IRS Form 1040—line 25. Don't
include extended foster care benefits, student aid, earned income credit, additional child tax credit, welfare
payments, untaxed Social Security benefits, Supplemental Security Income, Workforce Investment Act
educational benefits, on-base military housing or a military housing allowance, combat pay, benefits from
flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion or credit for federal tax on
special fuels.